596 Obstetrics and Gynecology Board Review •••
❍ What are two treatment options for patients with amenorrhea caused by a microadenoma who do not desire
pregnancy?
Dopamine agonist
Oral contraceptive pill
❍ When may treatment with dopamine agonists for hyperprolactinemia be stopped?
If the prolactin levels have been normal for 2 years and there is no evidence of adenoma on MRI, then cessation of
therapy can be considered. Prolactin level should be checked periodically as there is a significant rate of recurrence
(26% to 69% recurrence rate depending on the cause and study during 4–5 years of follow-up).
❍ Within what time period would one expect a recurrence in hyperprolactinemia for patients who have
stopped their dopamine agonists after having normal levels for 2 years?
Most common to have recurrence within 1 year.
❍ What is the recommended follow-up for patients for whom dopamine agonists have been tapered or
discontinued?
Prolactin level every 3 months for 1 year and then yearly prolactin level.
❍ What is the treatment of hyperprolactinemia secondary to hypothyroidism?
Thyroid hormones, only.
❍ Does the decidual endometrium have any endocrine function?
Yes. The secretion of prolactin.
❍ During pregnancy, what areas contribute to prolactin secretion?
The uterus, maternal and fetal pituitaries.
❍ Is the decidual secretion of prolactin affected by dopamine agonist treatment?
No.
❍ What area is typically being invaded in patients with prolactin levels >2000?
Cavernous sinuses.
❍ When treating macroadenomas, is it necessary to check frequent (every 3 months) MRIs?
No. Serum prolactin can be followed alone. MRI should be obtained 6 months after treatment.
❍ What is the classic visual field impairment seen in patients with macroadenomas?
Bitemporal hemianopsia.
❍ What is a malignant prolactinoma?
A prolactinoma that has metastases outside of the CNS (very rare).